Surgical Coronary Revascularization in Patients With Underlying Atrial Fibrillation: State-of-the-Art Review

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Atrial fibrillation (AF) affects 8-20% of patients undergoing coronary artery bypass grafting (CABG).
• AF is a significant risk factor, negatively impacting survival and increasing complication rates.
• Optimal management strategies for CABG in AF patients are crucial for improving patient outcomes.

Purpose of the Study:

• To provide a comprehensive review of current understanding, advancements, and strategies for CABG in patients with AF.
• To analyze key topics including stroke prevention, postoperative AF, surgical ablation, left atrial appendage occlusion, and on-pump vs. off-pump techniques.
• To offer practical recommendations for clinicians managing AF patients undergoing CABG.

Main Methods:

• State-of-the-art literature review.
• Analysis of evidence regarding stroke prevention, AF prophylaxis, and occurrence.
• Evaluation of surgical techniques: surgical ablation, left atrial appendage occlusion, on-pump vs. off-pump CABG.

Main Results:

• Preoperative surgical ablation improves prognosis without increasing perioperative risk in AF patients undergoing CABG.
• Off-pump CABG offers better short-term outcomes, while on-pump CABG may be beneficial long-term.
• Managing AF concomitantly with CABG is essential due to potential acute complications and long-term survival impacts.

Conclusions:

• Surgical ablation should be considered for preoperative AF in CABG patients.
• The choice between on-pump and off-pump CABG depends on balancing short-term and long-term outcomes.
• This review provides valuable insights and recommendations for optimizing care for AF patients undergoing CABG.